If you have more than 1 office location, share and office location, letterhead or cases with another attorney, provide details below in the comments box. Alternatively, you can fax an explanation on your letterhead to us at 732.542.1757 or email to ben@allprocoverage.com

In the last 12 months, how many attorneys have left your firm?

In the last 12 months, how many attorneys have joined your firm?

How many attorneys does the firm plan to add in the next 12 months?

In the last 12 months, how many non-attorneys have left your firm?

If your firm uses any attorneys not listed on this application to provide legal services, please advise name of each attorney here:

If you do not currently carry E&O Insurance, please advise why (to explain to the underwriters).

If any professional liability insurance for the applicant, or any member of the applicant firm ever been declined or cancelled, refused to be renewed or accepted only on special terms please advise why (to explain to the underwriters).

Does any client or group of related clients make up 10% or more of the firm’s annual gross receipts?

If yes, provide name of group (s) or client(s) here with percentage of annual gross receipt for each:

Does your firm accept any form of compensation other than legal fees?

Does or has any firm member introduced clients to one another for investment purposes?

Does the firm ever represent adverse but friendly parties in the same matter?

Name of Current Carrier (if none, state NONE)

Current policy term (mm/dd/yyyy)

Current Limits of Liability

Current Deductible

Retroactive Date (mm/dd/yyyy)

Expiring Premium, if you do not carry this coverage currently, state NONE

Is the firm or any attorneys currently covered by an extended reporting period endorsement?

For each attorney please provide the following:
1. Name of attorney:
2. States Admitted In:
3. Year First Admitted to Bar:
4. Years in practice:
5. Date joined firm:
6. Avg. # of hours/week:
7. Avg. # of CLE hours/year:
8. Status (Owner/Partner/Member/Counsel/Employed Lawyer/Independent Contractor):

If you are a sole practitioner, who handles your cases in the event of your incapacitation or vacation? Please Note: If a policy is issued in reliance upon this application, it shall not apply to the aforementioned attorney.

If applying as a Sole Practitioner for Part Time Coverage, are you employed in any capacity other than working as a Part Time Lawyer as applied for herein?

Total firm billings for the prior 12 months.

Total firm billings for the current 12 month period.

Has any professional liability claim or suit been made in the past five years against the firm or its predecessor or any current or former members of the firm or it’s predecessor firm(s) in the past five years?

Do you have knowledge of any circumstance, act, error, or omission that could result in a professional liability claim?

During the past ten years has any attorney mentioned here or any employee of the Applicant been the subject of a criminal action, reprimand, disciplinary action, bar complaint, investigation or other ethics proceeding? If yes, please explain below.

Has any member of the firm ever been refused admission to practice, disbarred, suspended, fined or held in contempt by any court or local bar association?

Have you ever had professional liability insurance cancelled or non renewed?

Does the Applicant have any high-profile clients who are entertainers, sports figures or public officials?

Has the firm been involved in any mass tort / class action cases within the past five years?

Does the Applicant have discretionary investment authority for any clients?

In the last five (5) years, has any attorney with the Applicant firm, represented any financial institution?

Has the Firm or any lawyer in the Firm represented publicly traded clients with
services rendered involving Sarbanes-Oxley Act (SOX) compliance including
but not limited to Securities, Accounting, Financial/Investment Services or Tax work?

Does any firm attorney serve as a director, officer, trustee (other than estate trusts), partner or employee of any client?

Does any firm member exercise fiduciary control or possess any ownership interest in any client or any business venture with a client?

Does your firm use engagement letters on all new matters?

Does the engagement letter include the identity of the client?

Does the engagement letter include the Scope of Representation that includes key terms of legal representation?

Does the engagement letter include the Fee structures and billing agreements?

Does the engagement letter include the Termination agreement that includes file retention and destruction terms?

Disclaimer Notice – The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.

Please utilize the “Send” Button to send your form to our office. If the website does not allow you to submit the form, please print the page and fax it to 732.334.0405 or scan it into your computer and send it to ben@allprocoverage.com. Do not “Refresh” the page because all data entered onto the form will be lost.

After you hit the “Send” button, please scroll back down to this area and if successfully sent, a message will appear below. If not successfully sent, a message will appear below which means you have to scroll back up and complete the missing information, which typically involves entering information into a highlighted box. Complete the missing information and then hit “Send” again. Thank you!

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